Special CME Issue - West Virginia State Medical Association

Recently, the US Court of Federal
Claims ruled that the “theory of
vaccine-related causation [of autism]
is scientifically unsupportable,”
that thimerosal-containing
vaccines do not cause autism.
How can we increase vaccine
uptake?
Physicians should initiate office
procedures that are proven to
increase immunization rates. First,
employ standing orders for influenza
and pneumococcal vaccines for
adults. We reported a retrospective
study of standing orders for elderly
patients that showed higher rates of
immunizations than when individual
orders were relied on at each
visit. 15 Second, communicate using
reminders for un-immunized at-risk
patients. Third, since Medicare data
for the US and West Virginia show
that only about two-thirds of elderly
adults have been immunized with
PPV23 we should take advantage
of opportunities to promote this
vaccine such as in the annual
Medicare wellness visit and when
patients present for their influenza
vaccine. Even though PPV23 can
be administered any time of the
year, data collected in our practice
showed that influenza vaccine season
provided the trigger to remind
physicians to offer PPV23. 16 Finally,
physicians should be advocates for
vaccines and provide education
about their need as uncertainty about
the need for H1N1 vaccine among
elderly in 2009 prevented many of
them from getting the vaccine. 17
The admonition that “an ounce
of prevention is worth a pound of
cure” applies to vaccines more than
any other medical advance. During
the past six decades established
and new vaccines pushed many
viral and bacterial diseases into the
background by preventing a myriad
of serious illnesses and saving untold
numbers of lives. The systematic,
appropriate and conscientious
use of vaccines among children
and adults in West Virginia will
promote their health and reduce
serious disease among them.
References
1. Immunization schedules from Centers for
Disease Control available at: http://www.
cdc.gov/vaccines/recs/schedules/default.
htm.
2. CDC. Update on Herpes Zoster Vaccine
Licensure for Persons Aged 50 Through 59
Years. MMWR 2011:1528.
3. WV DHHR Infectious Diseases
Epidemiology and Infectious Diseases
Surveillance Data 1999-2008 available at:
http://www.dhhr.wv.gov/oeps/disease/
Pages/default.aspx.
4. CDC website for immunization information
available at http://www.cdc.gov/vaccines/
pubs/surv-manual/index.html.
5. CDC. Pertussis – United States, 2001-
2003. MMWR 2005:54;1283-1286.
6. Mufson, M.A. Pneumococcus. In:
Schlossberg, D. (Ed.): Clinical Infectious
Disease, 3rd Edition, Cambridge University
Press, NY, NY. 2008. pp 1023-1030.
7. CDC. Prevention of pneumococcal
diseases among infants and Children –
Use of 13-valent pneumococcal conjugate
vaccine and 23-valent pneumococcal
vaccine – Recommendations of the
Advisory Committee on Immunization
Practices (ACIP). MMWR 2010:59;1-24.
8. Pilishvili T, Lexau C, Farley MM, Hadler J,
Harrison LH, Bennett NM, Reingold A,
Thomas A, Schaffner W, Craig AS, Smith
PJ, Beall BW, Whitney CG, Moore MR.
Active Bacterial Core Surveillance/
Emerging Infections Program Network;
Sustained reductions in invasive
pneumococcal disease in the era of
conjugate vaccine. J Infect Dis
2010;201:32-41.
9. CDC. Prevention and Control of Influenza
with Vaccines: Recommendations of the
Advisory Committee on Immunization
Practices (ACIP), MMWR 2011:60;1128-
1132.
10. CDC. Measles outbreak---Hennepin
County, Minnesota, February--March 2011.
MMWR 2011;60:421
11. CDC. Quadrivalent Human Papillomavirus
Vaccine - Recommendations of the
Advisory Committee on Immunization
Practices (ACIP). MMWR 2007;56;1-24.
12. CDC. Updated recommendations for use
of meningococcal conjugate vaccines –
Advisory Committee on Immunization
Practices (ACIP), MMWR 2011:60;72-76.
13. Eggertson L. Lancet retracts 12-year-old
article linking autism to MMR vaccines.
CMAJ. 2010;182:E199-200.
14. DeStefano F, Thompson WW. MMR
vaccine and autism: an update of the
scientific evidence. Expert Rev Vaccines.
2004 Feb;3:19-22.
15. Goebel LJ, Neitch SM, Mufson MA.
Standing orders in an ambulatory setting
increases influenza vaccine usage in older
people. J Am Geriatr Soc. 2005
Jun;53:1008-1010.
16. Goebel LJ, Mufson MA. Influenza season
triggers pneumococcal vaccination. J Am
Geriatr Soc. 2006 Aug;54(8):1261-1264.
17. Brown JR, Goebel LJ, Neitch SM, Tweel
HK, Mufson MA. Barriers to vaccinating the
elderly with H1N1 vaccine. Am J Med Sci.
2011 Jul;342:24-6.
CME Po s t-Te s t
4. A 65 year old man with a history of hypertension
only should receive the pneumococcal vaccine
a. every 5 years
b. 2 doses, 5 years apart
c. once
d. as PCV7 which is indicated for adults
5. Which is true about influenza vaccine?
a. It comes in a new high dose formulation
for people over age 65 years
b. Live attenuated vaccine is given by injection
c. Live attenuated vaccine is for people over age 50
d. People with fever and moderate illness
should still get the vaccine that visit
6. A 70 year old female has a new grandchild and
asks about Tdap vaccine. Which is true?
a. She doesn’t need it if she had
whooping cough as a child
b. She needs to wait until 10 years
after her last tetanus shot
c. She should not get it because it is
not indicated over age 65
d. She should get it as soon as possible
28 West Virginia Medical Journal